"Do you really need to audit the cleanliness of your commodes every week? It’s not unknown for staff in health and care settings to do just that – even in the midst of a pandemic. It’s on the audit questionnaire, so we’ve got to do it.”
Over the past 18 months, government ministers, scientists and healthcare experts have grappled to find the most efficient and effective ways of managing the spread of Covid-19. As knowledge grew and the scientific evidence developed, guidance, more guidance, and yet more guidance was published – usually on a Friday afternoon, putting paid to any notion of weekend ‘breaks’.
Nowhere, perhaps, was this more keenly felt than in Infection Prevention & Control (IPC) teams in healthcare settings and local authorities. Suddenly, IPC had taken on a renewed importance for care providers and public health teams seeking to minimise the risk of infection across hospitals, surgeries, care homes, schools, businesses – anywhere there was a risk of rapid spread, and potential mutation.
It’s pretty obvious that a dirty or damaged commode is an infection risk. But when your staff and wards are overwhelmed by rising numbers of seriously ill patients, and stretched to the limit managing extra workloads because their colleagues are also ill, is a weekly audit of commodes a sensible use of time?
A good audit is an essential tool in the fight to achieve the highest possible standards of patient care. It’s also valuable in meeting the assurance requirements of management, commissioners and regulators. But the trick to turning a good regular audit into a truly transformational tool is to STOP asking the questions you’ve always asked.
No, I don’t really want you to stop auditing. Of course I don’t – it’s my bread and butter. It is also the most fundamental source of vital information for your organisation and a driver for improvement. But what I do want you to do is to step back, and reconsider what it is you are auditing and why. What the pandemic has shown is that regimented auditing is not the most efficient way to drive improvements, when what you need is change - NOW.
From our knowledge of Perfect Ward users, we know that an average regular IPC audit involves 120 questions (about 23% of which cover cleanliness, tidiness and locating items), and takes a minimum of 45 - 90 minutes per month. Multiply that by the number of clinical and other areas being subjected to regular audits, and you can see that IPC can consume a huge amount of clinical time. (In addition, with so much information you might end up not seeing the wood for the trees.)
Audits which have become an ever-growing list of rigid, regular checks are not sustainable, take up valuable time, and won’t help the organisation to improve if what’s audited is never reviewed. This is even more the case in times of severe pressure. With winter on its way, and the system already under so much pressure that a lot of winter capacity within acute hospitals has already been opened to help manage the return to ‘business as usual’, now is a valuable opportunity to undertake that review.
In the face of a shortage of people, time and energy to carry out regular audits, what happened to auditing when the pandemic struck?
Many regular audits were put on hold during Covid peaks, but IPC audits were strengthened as the government issued its rapidly changing guidance (sometimes on what felt like a daily basis), and suddenly providers were having to submit not monthly organisation reports, but daily reports direct to NHS England. (Perfect Ward saw a 75% drop in regular audits across our customer base in April 2020.)
Recognising the pressures on audits, and the need to audit what really mattered, Perfect Ward also implemented a short, sharp Covid audit which tackled the key IPC issues of PPE availability, its correct use, and enabling and following social distancing.
The pandemic helped many Perfect Ward customers recognise that the need was to audit on the basis of ‘what makes a difference now’, and to audit where the real risks were. That holds good for audits at any time, not only in a pandemic.
Covid has not gone away, and other common infections including C.Diff, MSRA, influenza and norovirus, are on their way back. Reduced immunity from common respiratory illnesses is also impacting on demand, particularly Respiratory Syncytial Virus (RSV). So, while Covid may no longer be the central focus, IPC audits are as important as ever, and staffing capacity pressures are not going to be reduced any time soon.
Keeping staff motivated and engaged with audits is critical, remembering that audits are there to drive improvements and transform services. During the pandemic, audit-led improvements supported the major reduction in numbers of hospital-acquired infections. As Jay Turner-Gardner said of Wirral University Teaching Hospital NHS FT, “Last year we had no respiratory illnesses, and no norovirus. That was unheard of before the pandemic.”
So, as infections return alongside Covid, it is crucial that staff recognise the importance of the audit work and learn from Covid-19.
Over the past five years, we have seen audits transition from being an assurance tool to a key element of an improvement methodology. Used well, it will connect, engage and empower your staff to own the quality in their area.
For more information on Perfect Ward and our work in Infection Prevention and Control audits, read about 7 effective ways to transform your IPC strategy or contact us to find out more about our IPC audits.